踝关节骨折术后并发创伤性关节炎的影响因素分析
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摘要
目的分析踝关节骨折术后并发创伤性关节炎的影响因素。方法选取2013年1月至2018年1月行手术治疗的踝关节骨折患者138例,回顾性分析其临床资料。术后随访10个月,其中术后并发创伤性关节炎38例为发生组,余100例为未发生组。统计两组患者的一般资料,应用Logistic回归分析术后并发创伤性关节炎的影响因素。结果138例患者中创伤性关节炎的发生率为27. 54%,发生组患者年龄> 60岁、体质指数>23. 9 kg/m2、后踝骨折、体力劳动分级>Ⅱ级的构成比均高于未发生组(P <0. 05)。经Logistic回归分析,年龄> 60岁,OR=1. 354,95%CI=1. 001～3. 201;体质指数> 23. 9 kg/m2,OR=2. 354,95%CI=1. 524～4. 201;后踝骨折,OR=3. 896,95%CI=2. 420～6. 3521;体力劳动分级>Ⅱ级,OR=2. 121,95%CI=1. 010～3. 524。结论踝关节骨折术后并发创伤性关节炎的风险较大,年龄≥60岁、体质指数异常等均是独立危险因素。临床应制定相应预防措施,以减少术后创伤性关节炎。
Objective To analyze the influencing factors of traumatic arthritis after ankle fracture surgery. Methods The clinical data of 138 patients with ankle fracture underwent surgery from January 2013 to January 2018 were retrospectively analyzed. According to whether or not traumatic arthritis occurs after surgery,they were divided into the occurrence group( 38 cases) and the nonoccurring group( 100 cases). The general data of patients were collected,and the influencing factors of postoperative traumatic arthritis were analyzed by Logistic regression analysis. Results The incidence of traumatic arthritis in 138 patients was 27. 54%. The ratios of age > 60 years,BMI > 23. 9 kg/m2,posterior malleolar fracture and physical labor grade > II grade in the occurrence group were significantly higher than those in the non-occurrence group( P < 0. 05). According to Logistic regression analysis,age> 60 years old,OR = 1. 354,95% CI = 1. 001-3. 201; physical index > 23. 9 kg/m2,OR = 2. 354,95% CI = 1. 524-4. 201; posterior ankle fracture,OR = 3. 896,95% CI = 2. 420-6. 3521; manual labor Grading > Ⅱ class,OR = 2. 121,95% CI = 1. 010-3. 524. Conclusions The risk of traumatic arthritis after ankle fracture is higher,and age≥ 60 years,BMI > 23. 9 kg/m2 are all independent risk factors. Targeted preventive measures should be developed to reduce postoperative traumatic arthritis.
Objective To analyze the influencing factors of traumatic arthritis after ankle fracture surgery. Methods The clinical data of 138 patients with ankle fracture underwent surgery from January 2013 to January 2018 were retrospectively analyzed. According to whether or not traumatic arthritis occurs after surgery,they were divided into the occurrence group( 38 cases) and the nonoccurring group( 100 cases). The general data of patients were collected,and the influencing factors of postoperative traumatic arthritis were analyzed by Logistic regression analysis. Results The incidence of traumatic arthritis in 138 patients was 27. 54%. The ratios of age > 60 years,BMI > 23. 9 kg/m2,posterior malleolar fracture and physical labor grade > II grade in the occurrence group were significantly higher than those in the non-occurrence group( P < 0. 05). According to Logistic regression analysis,age> 60 years old,OR = 1. 354,95% CI = 1. 001-3. 201; physical index > 23. 9 kg/m2,OR = 2. 354,95% CI = 1. 524-4. 201; posterior ankle fracture,OR = 3. 896,95% CI = 2. 420-6. 3521; manual labor Grading > Ⅱ class,OR = 2. 121,95% CI = 1. 010-3. 524. Conclusions The risk of traumatic arthritis after ankle fracture is higher,and age≥ 60 years,BMI > 23. 9 kg/m2 are all independent risk factors. Targeted preventive measures should be developed to reduce postoperative traumatic arthritis.
引文
[1]戚晓阳,邱旭升,施鸿飞,等.踝关节骨折术后关节功能的影响因素分析[J].中华创伤骨科杂志,2017,19(9):762-768. DOI:10. 3760/cma. j. issn. 1671-7600. 2017. 09. 006.
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[6]夏海,杨瑜瑜,孙英华,等.踝关节骨折术后深静脉血栓形成发病率调查及影响因素分析[J].广东医学,2017,38(18):2830-2832. DOI:10. 3969/j. issn. 1001-9448. 2017. 18. 024.
[7]沈其孝,成文熠,刘康,等.高能量Pilon骨折手术疗效的相关影响因素分析[J].河北医药,2017,39(5):746-748. DOI:10. 3969/j. issn. 1002-7386. 2017. 05. 031.
[8]聂志刚,彭昊,方洪松,等.髋臼骨折术后并发创伤性关节炎的影响因素分析[J].实用骨科杂志,2018,24(5):399-404.
[9]许杰,吴启平,翟宏利,等.踝关节创伤性关节炎的关节镜治疗[J].生物骨科材料与临床研究,2018,15(2):36-39. DOI:10. 3969/j. issn. 1672-5972. 2018. 02. 009.
[10] Matson AP,Morwood MP,Peres DSA,et al. Obese patients have fewer wound complications following fixation of ankle fractures[J].Foot Ankle Spec,2017,10(5):146-148. DOI:10. 1177/1938640016685146.
[11]于振,窦强兵,袁先发,等. Endobutton钢板与皮质骨螺钉治疗伴踝关节骨折的急性下胫腓联合损伤的比较[J].安徽医药,2017,21(7):1223-1227. DOI:10. 3969/j. issn. 1009-6469. 2017. 07.014.
[2]王臻,纪斌,庞金辉.钢板内固定治疗胫骨平台骨折继发膝创伤性关节炎的危险因素分析[J].医学综述,2017,23(8):1656-1658. DOI:10. 3969/j. issn. 1006-2084. 2017. 08. 043.
[3] Louie PK,Schairer WW,Haughom BD,et al. Involvement of residents does not increase postoperative complications after open reduction internal fixation of ankle fractures:an analysis of 3251 cases[J]. J Foot Ankle Surg,2017,56(3):492-492. DOI:10. 1053/j. jfas. 2017. 01. 020.
[4]陶天遵.新编临床骨科学[M].北京:北京科学技术出版社,2002:1499-1450.
[5]罗雪峰,易知非,谢增如.踝关节骨折后发生骨质疏松的相关危险因素分析[J].创伤外科杂志,2018,20(1):49-52. DOI:10.3969/j. issn. 1009-4237. 2018. 01. 012.
[6]夏海,杨瑜瑜,孙英华,等.踝关节骨折术后深静脉血栓形成发病率调查及影响因素分析[J].广东医学,2017,38(18):2830-2832. DOI:10. 3969/j. issn. 1001-9448. 2017. 18. 024.
[7]沈其孝,成文熠,刘康,等.高能量Pilon骨折手术疗效的相关影响因素分析[J].河北医药,2017,39(5):746-748. DOI:10. 3969/j. issn. 1002-7386. 2017. 05. 031.
[8]聂志刚,彭昊,方洪松,等.髋臼骨折术后并发创伤性关节炎的影响因素分析[J].实用骨科杂志,2018,24(5):399-404.
[9]许杰,吴启平,翟宏利,等.踝关节创伤性关节炎的关节镜治疗[J].生物骨科材料与临床研究,2018,15(2):36-39. DOI:10. 3969/j. issn. 1672-5972. 2018. 02. 009.
[10] Matson AP,Morwood MP,Peres DSA,et al. Obese patients have fewer wound complications following fixation of ankle fractures[J].Foot Ankle Spec,2017,10(5):146-148. DOI:10. 1177/1938640016685146.
[11]于振,窦强兵,袁先发,等. Endobutton钢板与皮质骨螺钉治疗伴踝关节骨折的急性下胫腓联合损伤的比较[J].安徽医药,2017,21(7):1223-1227. DOI:10. 3969/j. issn. 1009-6469. 2017. 07.014.